June 2014 (Volume 2, Number 6)
This issue includes 4 AMA PRA Category 1 CreditsTM; and 4 AOA Cetegory 2A or 2B CME credits
Kevin Stiver, MD
Cardiovascular Fellow, Department of Internal Medicine, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH
Troy E. Rhodes, MD, PhD, FHRS, CCDS
Assistant Professor of Medicine, Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
Suparna Dutta, MD, MPH
Assistant Professor of Medicine, Division of Hospital Medicine, Rush University Medical College, Chicago, IL
Daniel Robitshek, MD, SFHM
Assistant Professor of Medicine, Medical College of Georgia; Program Director, Internal Medicine Residency, Associate Director, Hospitalist Program, Redmond Regional Medical Center, Rome, GA
Sudden cardiac arrest is often due to ventricular tachycardia or ventricular fibrillation, but on rare occasions, it can be caused by pulseless electrical activity or severe bradydysrhythmia. Sudden cardiac death may account for up to 15% of the total mortality in the United States and other industrialized countries. Sudden cardiac arrest can occur in the presence or absence of structural heart disease, though it is most commonly seen in patients with coronary heart disease. This review will aid hospitalists in identifying reversible and nonreversible causes of sudden cardiac arrest, with recommendations on performing a thorough history, physical examination, and diagnostic studies, and it reviews the evidence on the most effective treatment and primary prevention strategies. Prevention of recurrent arrest is a central goal of long-term management, and an implantable cardioverter-defibrillator is the proven approach for secondary prevention. Effective use of antiarrhythmic drugs, therapeutic hypothermia, and a summary of recommendations for screening of athletes are also reviewed.
Excerpt From This Issue
A 65-year-old man with a history of coronary artery disease status post CABG, prior myocardial infarction, and ongoing tobacco use had a witnessed syncopal episode at home. He had agonal breathing, and there was no pulse. His wife began CPR and called 911. When EMS arrived, he was connected to an automated external defibrillator, which advised a shock be delivered. Following defibrillation, a pulse was detected and he was transported to his local emergency department. He underwent coronary angiography, which showed 3-vessel coronary artery disease with patent bypass grafts. Transthoracic echocardiography showed left ventricular ejection fraction of 30%. As a hospitalist working with the cardiology group, the patient is admitted to your service from the cardiac catheterization lab.